Ductus Venosus in the First Trimester: Contribution to Screening of Chromosomal, Cardiac Defects and Monochorionic Twin Complications

Maíz, Nerea; Nicolaides, Kypros H.

doi:10.1159/000314036

Cited by 71 publications

(57 citation statements)

References 79 publications

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“…Maiz and Nicolaides reported that an abnormal flow in the DV was observed in 69.1% of trisomy 21 fetuses, and in 3.7% of chromosomally normal fetuses [5,17]. First reports of the use of the DV flow assessment in trisomy 21 screening have been published in 1990's [16].…”

Section: Discussionmentioning

confidence: 99%

Screening for trisomy 21 based on maternal age, nuchal translucency measurement, first trimester biochemistry and quantitative and qualitative assessment of the flow in the DV — the assessment of efficacy

Czuba

Zarotyński²,

Dubiel

et al. 2017

Ginekol Pol

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Objectives: The aim of the study was to compare effects of addition of two methods of ductus venosus (DV) flow assessment: qualitative -the assessment of shape of the A-wave (positive or negative), and quantitative -based on the pulsatility index for veins (DVPI) to the basic screening for trisomy 21 at 11 to 13 + 6 weeks of pregnancy. Material and methods:The ultrasound examination was performed in 8230 fetuses in singleton pregnancies at 11--13 + 6 wks, as a part of a routine screening for chromosomal defects. In DV A-wave was assessed and DVPI was calculated. After the scan blood sample was taken for first trimester biochemistry (BC). Risk for chromosomal defects was calculated and high-risk patients were offered an invasive test for karyotyping.Results: Basic screening with following combination of markers: MA, NT and BC provided lowest detection rate (DR) 87.50% for FPR = 6.94%. After adding qualitative DV A-wave assessment DR increased to 88.75% for FPR = 5.65%. The best DR = 93.75% for FPR = 5.55% was achieved when quantitative DVPI was added. The application of the Receiver Operating Curves curve confirmed validity of the addition of DV flow assessment to the screening model. The highest diagnostic power of the test was achieved when DVPI was added, with the ROC AUC of 0.974. Conclusions:The assessment of DV flow performed at 11-13 + 6 weeks increases DR for trisomy 21 and reduces FPR. The screening model based on the quantitative DV flow analysis (DVPI) gives better results compared to the qualitative flow assessment.

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Section: Discussionmentioning

confidence: 99%

Screening for trisomy 21 based on maternal age, nuchal translucency measurement, first trimester biochemistry and quantitative and qualitative assessment of the flow in the DV — the assessment of efficacy

Czuba

Zarotyński²,

Dubiel

et al. 2017

Ginekol Pol

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“…There is also evidence that serum PLGF and AFP are useful in first-trimester screening for preeclampsia, fetal growth restriction and preterm birth [16,17,18]. Similarly, measurement of DV PIV can improve the performance of screening for trisomies and it is also useful in screening for major cardiac defects [7,19,20]. …”

Section: Discussionmentioning

confidence: 99%

First-Trimester Screening for Trisomies 21, 18 and 13 by Ultrasound and Biochemical Testing

et al. 2013

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Objective: To examine the performance of screening for trisomies 21, 18 and 13 at 11-13 weeks' gestation using specific algorithms for these trisomies based on combinations of fetal nuchal translucency thickness (NT), fetal heart rate (FHR), ductus venosus pulsatility index for veins (DV PIV), and serum free β-human chorionic gonadotropin (β-hCG), pregnancy-associated plasma protein A (PAPP-A), placental growth factor (PLGF) and α-fetoprotein (AFP). Methods: Model-based estimates of screening performance were produced for the distribution of maternal ages in England and Wales in 2011, and prospectively collected data on fetal NT, FHR, DV PIV, β-hCG, PAPP-A, PLGF and AFP from singleton pregnancies undergoing aneuploidy screening. Results: In screening by NT, FHR, free β-hCG and PAPP-A, using specific algorithms for trisomy 21 and trisomies 18 and 13 at the risk cutoff of 1:100, the estimated detection rate (DR) was 87.0% for trisomy 21 and 91.8% for trisomies 18 and 13, at a false-positive rate (FPR) of 2.2%. Addition of PLGF, AFP and DV PIV increased the DR to 93.3% for trisomy 21 and 95.4% for trisomies 18 and 13 and reduced the FPR to 1.3%. Conclusions: Effective screening for trisomies can be achieved using specific algorithms based on NT, FHR, DV PIV, β-hCG, PAPP-A, PLGF and AFP.

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“…Additionally, these metabolites are useful in first-trimester screening for preeclampsia, fetal growth restriction and preterm birth [26,27,28]. Measurement of DV PIV can improve the performance of screening for trisomies considerably and it is also useful in screening for major cardiac defects [29,30,31]. However, competence in this examination requires extensive experience in the 11- to 13-week scan and specific training [32]; the test is at present carried out in specialist centres and is unlikely to be used universally in first-line screening.…”

Section: Discussionmentioning

confidence: 99%

First-Trimester Contingent Screening for Trisomies 21, 18 and 13 by Biomarkers and Maternal Blood Cell-Free DNA Testing

et al. 2013

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Objective: To examine potential performance of screening for trisomies by cell-free (cf) DNA testing in maternal blood contingent on results of first-line testing by combinations of fetal translucency thickness (NT), fetal heart rate (FHR), ductus venosus pulsatility index (DV PIV), and serum-free β-human chorionic gonadotropin (β-hCG), pregnancy-associated plasma protein-A (PAPP-A), placental growth factor (PLGF) and α-fetoprotein (AFP). Methods: Performance was estimated for firstly, screening by cfDNA in all pregnancies and secondly, cfDNA testing contingent on results of first-line testing by combinations of ultrasound and biochemical markers. Results: In first-line screening by cfDNA testing, the detection rate for trisomy 21 and trisomies 18 or 13 would be 99 and 96%, respectively, after invasive testing in 1% of the population. In contingent screening, a detection rate of 98% for trisomy 21 and 96% for trisomy 18 or 13, at an invasive testing rate of 0.7%, can be achieved by carrying out cfDNA testing in about 35, 20 and 11% of cases identified by first-line screening with the combined test alone (age, NT, FHR, β-hCG, PAPP-A), the combined test plus PLGF and AFP and the combined test plus PLGF, AFP and DV PIV, respectively. Conclusions: Effective first-trimester screening for trisomies can be achieved by contingent screening incorporating biomarkers and cfDNA testing.

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Ductus Venosus in the First Trimester: Contribution to Screening of Chromosomal, Cardiac Defects and Monochorionic Twin Complications

Cited by 71 publications

References 79 publications

Screening for trisomy 21 based on maternal age, nuchal translucency measurement, first trimester biochemistry and quantitative and qualitative assessment of the flow in the DV — the assessment of efficacy

Screening for trisomy 21 based on maternal age, nuchal translucency measurement, first trimester biochemistry and quantitative and qualitative assessment of the flow in the DV — the assessment of efficacy

First-Trimester Screening for Trisomies 21, 18 and 13 by Ultrasound and Biochemical Testing

First-Trimester Contingent Screening for Trisomies 21, 18 and 13 by Biomarkers and Maternal Blood Cell-Free DNA Testing

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